Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne, Victoria, Australia.
Queensland Aphasia Research Centre, Surgical, Treatment and Rehabilitation Service, University of Queensland, Brisbane, Queensland, Australia.
Hum Brain Mapp. 2024 Apr;45(5):e26665. doi: 10.1002/hbm.26665.
Cognitive deficits are a common and debilitating consequence of stroke, yet our understanding of the structural neurobiological biomarkers predicting recovery of cognition after stroke remains limited. In this longitudinal observational study, we set out to investigate the effect of both focal lesions and structural connectivity on poststroke cognition. Sixty-two patients with stroke underwent advanced brain imaging and cognitive assessment, utilizing the Montreal Cognitive Assessment (MoCA) and the Mini-Mental State Examination (MMSE), at 3-month and 12-month poststroke. We first evaluated the relationship between lesions and cognition at 3 months using voxel-based lesion-symptom mapping. Next, a novel correlational tractography approach, using multi-shell diffusion-weighted magnetic resonance imaging (MRI) data collected at both time points, was used to evaluate the relationship between the white matter connectome and cognition cross-sectionally at 3 months, and longitudinally (12 minus 3 months). Lesion-symptom mapping did not yield significant findings. In turn, correlational tractography analyses revealed positive associations between both MoCA and MMSE scores and bilateral cingulum and the corpus callosum, both cross-sectionally at the 3-month stage, and longitudinally. These results demonstrate that rather than focal neural structures, a consistent structural connectome underpins the performance of two frequently used cognitive screening tools, the MoCA and the MMSE, in people after stroke. This finding should encourage clinicians and researchers to not only suspect cognitive decline when lesions affect these tracts, but also to refine their investigation of novel approaches to differentially diagnosing pathology associated with cognitive decline, regardless of the aetiology.
认知缺陷是中风的常见且使人虚弱的后果，但我们对预测中风后认知恢复的结构神经生物学生物标志物的理解仍然有限。在这项纵向观察性研究中，我们着手研究局灶性病变和结构连接对中风后认知的影响。62 名中风患者在中风后 3 个月和 12 个月接受了高级脑部成像和认知评估，使用蒙特利尔认知评估（MoCA）和简易精神状态检查（MMSE）。我们首先使用基于体素的病变-症状映射来评估 3 个月时病变与认知之间的关系。接下来，使用多壳扩散加权磁共振成像（MRI）数据在两个时间点进行的新的相关轨迹追踪方法，用于在 3 个月时评估白质连接组与认知之间的横向关系，并进行纵向评估（12 减去 3 个月）。病变-症状映射未产生显著发现。相反，相关轨迹追踪分析表明，MoCA 和 MMSE 评分与双侧扣带束和胼胝体之间存在正相关，这在 3 个月时既是横向的，也是纵向的。这些结果表明，在中风后人群中，支持使用 MoCA 和 MMSE 这两种常用认知筛查工具的表现的是一致的结构连接组，而不是局灶性神经结构。这一发现应鼓励临床医生和研究人员不仅在病变影响这些束时怀疑认知能力下降，而且还应改进他们对与认知能力下降相关的病理的新方法进行差异诊断的调查，无论病因如何。
